There are some key facts you should know before you conceive as they can sometimes make a big difference to your pregnancy. These range from checking that you are immune to rubella to knowing what foods to avoid that might cause you a problem.
Rubella
must know
Immunization before conception
If you are not immune to German measles, you should be immunized before trying to become pregnant. It is then essential to use effective contraception for three months afterwards to avoid getting pregnant. Immunization can not be given during pregnancy as the vaccine is itself a live virus and could cause problems for the baby.
Probably better known as German measles, Rubella is a very common infection in children and most children either contract it in childhood or are immunized against it. It is usually a mild condition with a transient rash and swelling of the lymph glands behind the ears. It is caught from airborne droplets that spread when infected people cough or sneeze. German measles, if caught in pregnancy, particularly in the first three months, can cause malformations in your baby. These may include deafness, blindness and heart problems. However, it can only be caught if you are not immune to it, so it is important to know if you are immune to German measles before you try to conceive.
In the UK, children are routinely immunized against German measles, so the vast majority of women are immune. If you’re not sure that you have been immunized, your GP should have a record, or your parents may remember. Once you have had rubella or been immunized against it, you should be immune to it. It is rare to lose immunity. If there is any doubt, immunity to German measles can be checked with a simple blood test.
Toxoplasma
Toxoplasma is an organism that usually lives in cats and is found in soil, where it can remain viable for many months. It is excreted in cat feces, so litter trays are potentially a source of infection. Contaminated meat (those most commonly implicated are raw, cured and undercooked meats) and soil-covered vegetables are also a source of infection, so always wash your hands thoroughly after touching soil or raw meat. If gardening, wear rubber gloves.
Recently, it has been found that cats are not the most common source of toxoplasma infection. This may be because cats excrete toxoplasma in their feces only for the first two weeks after they have been infected for the first time. But wear rubber gloves when emptying a cat litter tray as a precaution.
This infection, which can pass from the mother to the developing baby in the womb, has many features in common with congenital rubella. Although it is often asymptomatic in healthy adults, it can sometimes cause particular problems in pregnancy. Toxoplasma infection in adults is usually symptomless or mild, presenting as a mild viral illness. If concerned, your doctor will take a blood test.
Infection of the baby is more likely to occur in later pregnancy, but the risk of damage at this stage is less than in early pregnancy, when it can be a cause of serious abnormalities or lead to miscarriage. However, it is uncommon for babies to be affected in the womb.
• Only about 1-10 out of every 10,000 newborn babies in Europe are infected.
• Overall, about 70 per cent of these infected babies have no associated problem, around ten per cent have eye problems and the remainder have similar problems to those seen with German measles infection.
If a toxoplasma infection is suspected in the baby, you will need regular ultrasound examinations and sometimes samples of the baby’s blood or amniotic fluid are required to diagnose. The infection can be treated with an antibiotic called spiramycin.
Your weight
It is a fact – young women in the UK are getting heavier. In a little over ten years, the number of women who have a body mass index in the obese range has doubled. While we all know that being very overweight is bad for our health, few women are aware of just how their weight can influence their pregnancy. This is important to know as your weight is something that you can influence before you think about conceiving, and by doing so you make a difference to your health and your pregnancy.
Potential problems associated with weight
If you are trying to conceive and you are seriously overweight or underweight, discuss this with your doctor. Extremes of weight are associated with an increased risk of problems in pregnancy.
• Underweight mothers are more at risk of problems, such as having a small-for-dates baby or going into premature labour.
• Overweight mothers are at risk of problems such as chronic high blood pressure and pre-eclampsia – a serious pregnancy condition related to high blood pressure, which can lead to kidney upset and risk to the baby.
In addition, both extremes of weight can be associated with fertility problems. You don’t want to have to contemplate dieting when you are pregnant, so it is important to think about reducing your weight long before trying to get pregnant.
The proportion of people who are overweight in developed countries is increasing. In the UK, around 30 per cent of women are overweight. In the last 10-15 years there has been a doubling in the number of pregnant women who fall into the obese category with their BMI. In the UK today, around 1:5 women who are pregnant are in this obese category and this number is steadily increasing. This is really important as the risk of pregnancy complications is increased in mothers who are obese.
Appropriate weight before pregnancy
There is no ‘ideal’ weight for a woman before pregnancy. Your ‘ideal’ weight depends on you as an individual and it is not based on what you weigh when you stand on the scales. The way to work out if your pre-pregnancy weight is satisfactory is to calculate your body mass index (BMI), see the box below, and compare the resulting figure with the gradings of BMI given below. This is probably the best guide to weight as it gives a better indication of body fat content than weight alone, both in pregnant and non-pregnant women. It also takes into account your height, which obviously influences what you should weigh.
The underweight and obese BMI categories are associated with fertility and pregnancy problems. Although it is probably best to be in the normal range before pregnancy, the overweight range is not usually associated with major problems. However, there is some change in the level of risk even in the overweight category. This emphasizes just how important it is to look after your weight.
Body shape
It is not just the quantity of fat you have in your body that matters, but also where it is in your body. Women who are ‘pear-shaped’, with fat principally on their buttocks and thighs, are at less risk of health problems than those who are ‘apple-shaped’, carrying fat on their abdomen. Fat in the abdomen influences the metabolism of sugar and fats in your body, with resulting higher levels of sugar and fats in your bloodstream, much more than does fat on your hips. The problems that can be associated with these changes in your metabolism include a risk of pre-eclampsia when you are pregnant and also heart disease in later life. In the last 10 or 15 years it has become clear that waist circumference is a risk factor for heart disease. Indeed, measuring waist circumference has been advocated as a health-screening test.
• Measure around your waist without any clothes on and do not pull the tape tight; let it lightly rest on the skin.
• Compare the resulting measurement to the table shown opposite.
It has been calculated that a waist circumference of 80 cm (31½in) or more in early pregnancy almost doubles the risk of high blood pressure and almost triples the risk of pre-eclampsia. Pre-eclampsia is